Emerging Therapies for Bipolar Disorder: A Clinical Update新兴治疗双相情感障碍：临床更新

With the number of approved agents for the treatment of mania and depression nearly tripling, appropriate management of bipolar disorder has become increasingly complex over the last decade.随着一些代理人批准用于治疗躁狂抑郁症和近两倍，适当的管理躁郁症已成为日益复杂的过去十年。 Until relatively recently, the mainstay treatment of bipolar disorder included lithium, divalproex, and, to a lesser extent, carbamazepine.直到最近，主体治疗双相情感障碍包括锂电池， divalproex ，并在较小的程度上，卡马西平。 However, with the approval of all of the atypical antipsychotics, as well as the approval of the novel antiepileptic agent lamotrigine as a maintenance therapy, our armamentarium for managing bipolar disorder has increased significantly.然而，在征得所有的抗精神病药物，以及批准新的抗癫痫剂拉莫三嗪作为维持疗法，我们的物质管理躁郁症已大大增加。

The prevalence of the disease, treatment outcomes, and key side effects of lamotrigine and the atypical antipsychotics, olanzapine and quetiapine, were featured topics at this year's APA meeting.流行的疾病，治疗结果，关键的副作用拉莫三嗪和抗精神病药物，奥氮平与奎，有特色的主题在今年的协会会议。 In addition, 2 novel approaches to treatment for bipolar depression -- repetitive transcranial magnetic stimulation and vagus nerve stimulation -- were discussed, as well as the importance of psychoeducation as a component of a comprehensive treatment plan for bipolar disorder.此外， 2个新的办法来治疗双极性抑郁症-重复经颅磁刺激和迷走神经刺激-进行了讨论，以及重要性ps ychoeducation作为一个组成部分的综合治疗计划躁郁症。

Lamotrigine拉莫三嗪

Lamotrigine received approval from the US Food and Drug Administration (FDA) for the maintenance treatment of bipolar I disorder in 2003, but appears to have better efficacy for prevention of relapse into depression than for the treatment of mania. ^[1] Several large, randomized, placebo-controlled trials have supported the use of lamotrigine in the treatment of bipolar disorder. ^[2-7] A recent open-label study of lamotrigine suggests that it improves clinical severity in patients with bipolar disorder either as a monotherapy or in combination with valproate, with similar results. ^[8] In this same open-label trial, self-reported quality of life enjoyment and cognitive function scores improved over 12 weeks when lamotrigine was added to ongoing bipolar therapy. ^[9] However, the data supporting the use of lamotrigine for treatment of bipolar depression are mixed: Some studies showed that the agent produced significant improvement over placebo, ^[2] but in at least 1 study, no significant improvement for bipolar I disorder was shown, and in another, improvement for bipolar I disorder, but not bipolar II, was observed. ^[10]拉莫三嗪获得批准美国食品和药物管理局（ FDA ）的维持治疗双极紊乱我在2003年，但似乎有更好的疗效，以防止抑郁症复发比治疗躁狂症。 ^{[ 1 ]}几个大型，随机，安慰剂对照试验支持使用拉莫三嗪治疗躁郁症。 ^{[ 2-7 ]}最近的一项开放标签拉莫三嗪的研究表明，它提高了临床严重程度患者的双相情感障碍作为一种单一或结合丙戊酸钠，与类似的结果。 ^{[ 8 ]}在同一开放标签试验，自报生活质量的享受与认知功能评分改善了12个星期时，拉莫三嗪添加到正在进行的两极治疗。 ^{[ 9 ]}但是，这些数据支持使用拉莫三嗪治疗双极性抑郁症是喜忧参半：一些研究表明，代理人产生了重大的改进安慰剂^， [ 2 ] ，但至少有1研究中，没有显着改善我的双极紊乱结果表明，在另一个改进两极余障碍，但不是两极二，观察。 ^{[ 10 ]}

Lamotrigine-Associated Rash拉莫三嗪相关的皮疹

One of the most severe and troubling potential side effects associated with the use of lamotrigine is a rash, which, in severe cases, can lead to toxic epidermal necrolysis or Stevens-Johnson syndrome.其中最严重和令人担忧的潜在副作用，使用拉莫三嗪是一种皮疹，在严重的情况下，可导致毒性表皮坏死松解症或Stevens - Johnson综合征。 Dr. Joseph R. Calabrese, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio, described the appropriate clinical management of lamotrigine-associated rash in his presentation at the APA meeting. ^[11] Although the percentage of patients experiencing a benign rash in lamotrigine studies was roughly equivalent in the active treatment placebo groups, there was a higher rate of dropout because of the side effect (6.3% dropout rate in the lamotrigine 200-mg group and 4.7% in the 50-mg group vs 3% dropout rate in the placebo group). ^[12] To reduce the potential for rash, Dr. Calabrese suggests gradual uptitration of the dosing, starting with 25 mg for the first 2 weeks, 50 mg for Weeks 3 and 4, and increasing to 100 mg and 200 mg in Weeks 5 and 6.约瑟夫博士Calabrese ，凯斯西储大学医学院和大学医院的克利夫兰，美国俄亥俄州克里夫兰市，叙述了适当的临床管理拉莫三嗪相关的皮疹在他的演示在协会会议。 ^{[ 11 ]}虽然所占的百分比例经历了良性皮疹在拉莫三嗪的研究大致相当于是在积极治疗安慰剂组，有较高的辍学，因为副作用（ 6.3 ％ ，辍学率在拉莫三嗪200毫克组和4.7 ％的50毫克组与3 ％的辍学率在安慰剂组） 。 ^{[ 12 ]}为了减少潜在的皮疹，医生建议Calabrese逐步uptitration的剂量开始， 25毫克的第一2周， 50毫克的周3和第4款，增加至100毫克， 200毫克，周5和6 。 Drug interactions are particularly important to consider; in particular, the dose of lamotrigine should be halved when used in conjunction with divalproex and doubled when used with carbamazepine.药物的相互作用是特别重要的考虑，特别是在拉莫三嗪剂量应减半使用时，连同一倍divalproex和使用，卡马西平。